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General NPI Number Information
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NPI Number | 1871807214
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Entity Type | Individual
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Provider Name | DUSTIN EDWARD THOMPSON MD
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Gender | Male
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 4201 SAINT ANTOINE ST DRH 3L8 DEPARTMENT OF RADIOLOGY
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-3433
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Fax |
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Provider Business Mailing Address
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Address Line | 4056 3 OAKS DR APT 2A
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City | TROY
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State | MI
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Zip | 48098-4551
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Country | US
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Telephone | 562-640-0434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301092721
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License Number State | MI
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